City of Minneapolis Environmental Services Well applications

City of Minneapolis Environmental Services Well applications

For reasonable accommodations or alternative formats please contact the Minneapolis Health Department at 612-673-3000.

People who are deaf or hard of hearing can use a relay service to call 311 agents at 612-673-3000. TTY users call 612-673-2157 or 612-673-2626.

Para asistencia 612-673-2700 Rau kev pab 612-673-2800

Hadii aad Caawimaad u baahantahay 612-673-3500

Please select the application you wish to complete.

There are options on each application on how you want to complete the fee collection, either by DocuSign or by telephone.

Application*

Well Construction

Well Sealing

Well Construction application

Failure to submit a notification prior to sealing an environmental well is a violation of Minnesota Statutes, Chapter 103I, Minnesota Rules Chapter 4725, and Minneapolis Ordinances Chapters 48 and 216.

I understand that all information provided in this notification is true and complete. I understand that misstatements of facts may result in forfeiture of all rights to licensure/registration as a well contractor/monitoring well contractor in accordance with Minnesota Statues, Chapter 103I.

If the well owner is not the property owner, Minnesota Statues, Chapter 103I.205, Subdivision 8, requires that, “A person may not construct or have constructed a well for the person’s own use on the property of another until the owner of the property on which the well is to be located and the intended well user sign a written agreement that identifies which party will be responsible for obtaining all permits or filing notification, paying applicable fees and for sealing the well. If the property owner refuses to sign the agreement, the intended well users may, in lieu of a written agreement, state in writing to the Commissioner that the well user will be responsible for obtaining permits, filing notification, pay applicable fees, and sealing the well. Nothing in this subdivision eliminates the responsibilities of the property owner under this chapter, or allows a person to construct a well on the property of another without consent of other legal authority.” A signed agreement must be included with if the property owner and intended well user are not the same person or company.

Well Sealing application

Well address or location*

Site name*

Property Owner

Property owner*

Full name of company, organization, or individual

Property owner address*

Include city, state, and ZIP

Property owner contact person*

List their name and title (if applicable)

Property owner telephone*

Phone

Property owner email address*

Well Owner

Is the property owner and well owner the same?*

Select

Well owner*

Full name of company, organization, or individual

Well owner address*

Include city, state and ZIP

Well owner phone*

Phone

Well owner email*

Well contractor information

Well contractor company owner*

Well contractor address*

Please include city, state & ZIP

Well contractor contact person*

Well contractor telephone*

Phone

Well contractor email*

This is the email that will receive notifications about this application, as well as receiving the permit and receipt to

Well contractor company license number*

Well company license expiration date*

Print licensed or registered contractor name*

This will count towards the signature requirement of the application

Type of well to be sealed*

Select one from the list or enter the type of well in the space below

Select or enter value

Type of well to be constructed*

Select one from the list or enter the type of well in the space below

Select or enter value

Well Sealing information

Well conditions - submit plans if any of these conditions exist for a well

Is the well obstructed?*

Select

Does the well have any annular space between casings or the borehole?*

Select

Does the well penetrate a confining layer?*

Select

Are any of the wells currently finished below grade? If so, explain below.*

Select

Below grade explanation*

At grade wells submit?*

Why the well cannot terminate 12 inches above grade and a diagram of the well cap and vault or manhole.

Select

Confining layer?*

Construction through a confining layer, multi-cased or multi-aquifer wells submit construction plan that includes: well diameter, grout material, drilling method, grouting method, casing materials, cross-sectional diagram of the well, and cross-section of anticipated geology.

Select

Is the well to be constructed in the Minneapolis right-of-way? An encroachment permit needs to be obtained prior to issuance of a city permit. For an encroachment permit, contact Minneapolis Public Works engineering design, Right-of-Way department.*

Select

Variance?*

Is a variance required? The Minnesota Department of Health must approve all variance requests.

Select

Variance number*

Enter the variance number here

Well advisory area*

For wells constructed in a well construction advisory area, approval must be obtained from Minnesota Department of Health, submit a copy of their approval. See below for definition.

Yes

Well Advisory Area

A Special Well and Boring Construction Area (SWBCA), sometimes also called a well advisory, is a mechanism that provides for controls on the construction, repair, and permanent sealing of wells and borings in an area where groundwater contamination has resulted in, or may result in, risks to public health. Special Well and Boring Construction Areas inform the public of potential health risks in areas where significant groundwater contamination exists; assure the proper construction, repair, and permanent sealing of wells and borings within the area; prevent exposure to groundwater contamination; and prevent the spread of groundwater contamination through improperly constructed or sealed wells and borings.

• CMC Heartland Lite Yard Site - Effective April 1, 2005.

This area includes the area bounded by East 26th Street on the north, 26th Avenue on the east, Lake Street on the south, and Bloomington Avenue South on the west, within the city of Minneapolis. This area includes the Southeast ¼ of Section 35 and the Southwest ¼ of Section 36 of Township 29, Range 24, Hennepin County.

• Twin Cities Army Ammunition Plant (TCAAP) - Effective April 20, 2016, revised July 1, 1996, revised June 1999.

Parts of Sections 4 and 33, and all of Sections 7-10, 15-22, and 27-32, Township 30 North, Range 23 West, Ramsey County; parts of Sections 4, 9, 16 and 30-32, and all of Sections 5-8,17-20, and 29, Township 29 North, Range 23 West, Ramsey and Hennepin Counties; parts of Sections 12, 13 and 24, all of Sections 25 and 36, Township 30 North, Range 24 West, Anoka County; and parts of Sections 14 and 23-25, and all of Sections 1, 12, and 13, Township 29 North, Range 24 West, Hennepin County.

Well #1

Township*

Select

Range*

Select

Section*

Small quarter*

Select

Mid quarter*

Select

Large quarter*

Select

Unique well number*

Well Head Finish (Above or At-grade) 1*

If below grade, explain in the space below

Select or enter value

Depth (Ft) 1*

H series 1*

Well 1 sealing date*

Construction start date

Construction profile

Enter at least the first well casing, there are three additional profiles for additional wells if necessary

Casing type*

Diameter*

From depth*

To depth*

Grouting plans

Enter at least the first well grouting plans, there are three additional profiles for additional wells if necessary

Material 1*

Yards 1*

Grouting from depth 1*

Grouting to depth 1*

Bags 1*

Do you have a second well to seal?*

If no, then your application ends here. If yes, 3 additional well entries will open for you to complete.

Yes

Do you have a second (or more) wells to construct?*

If no, then your application ends here. If yes, 3 additional entries will open for you to complete.

Yes

Township 2

Range 2

Section 2

Small 2

Quarters 2

Large 2

UWN 2

Well Head Finish (Above or At-grade) 2

If below grade, explain in the space below

Depth (Ft) 2

H-series 2

Well sealing date 2

Well construction date 2

Casing Type 2*

Diameter 2

From 2

To 2

Material 2

Yards 2

Bags 2

Grouting from depth 2

Grouting to depth 2

Township 3

Range 3

Section 3

Small 3

Quarters 3

Large 3

UWN 3

Well Head Finish (Above or At-grade) 3

If below grade, explain in the space below

Depth (Ft) 3

H-series 3

Well sealing date 3

Well construction date 3

Casing Type 3

Diameter 3

From 3

To 3

Material 3

Yards 3

Bags 3

Grouting from depth 3

Grouting to depth 3

Township 4

Range 4

Section 4

Small 4

Quarters 4

Large 4

UWN 4

Well Head Finish (Above or At-grade) 4

If below grade, explain in the space below

Depth (Ft) 4

H-series 4

Well sealing date 4

Well construction date 4

Casing Type 4

Diameter 4

From 4

To 4

Material 4

Yards 4

Bags 4

Grouting from depth 4

Grouting to depth 4

Attachments section

Add your attachments here for any of the following:

details of the well locations on the property
plans that detail the well conditions
well sealing details
well construction details
if necessary/required, any additional details to assist in the approval process of your application

Note: if the property owner is not the same as the well owner, submit a signed document of their signature as another attachment

Attachments - you can add more than one attachment for your application*

Drag and drop files here or

Collection of payment fee*

Use electronic method - DocuSign to collect

Please call me to obtain credit card info

Data Privacy Advisory

As part of the application process, you may provide payment information to pay the appropriate fee for your Application or Notification. Some payment information (e.g., credit card and bank account data) is protected under the Minnesota Government Data Practices Act. You are not required to provide this payment information. If you do provide your credit card data or bank account data, after your Application or Notification is processed and approved, your credit card will be charged the appropriate amount or your bank account data (e.g., check) will be used for payment. If you refuse to provide either of these forms of payment, you would have to use another means of payment. This application, the City’s website, or staff will provide information on the other means of payment.

If you submit your credit card data or bank account data at any point in the payment process, individuals who may access the data include individuals in the City who reasonably require access to process your Application or Notification and your payment and to perform related duties; attorneys representing those individuals; auditors; and others who are legally authorized to access the data.

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